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. 2019 Mar 11:2019:1217838.
doi: 10.1155/2019/1217838. eCollection 2019.

The Impact of Addition of Consolidation Chemotherapy to Standard Cisplatin-Based Chemoradiotherapy in Uterine Cervical Cancer: Matter of Distant Relapse

Vanessa A Fabri  1 , Ana C M Queiroz  1 , Henrique Mantoan  2 , Solange M Sanches  1 , Andrea P G Guimarães  1 , Adriana R G Ribeiro  1 , Ronaldo P Souza  1 , Joyce M L Maya  1 , Elizabeth S Santos  1 , Fabrício S Castro  1 , João P N S Lima  1 , Michael J Chen  3 , Glauco Baiocchi  2 , Alexandre A B A da Costa  1
Affiliations

The Impact of Addition of Consolidation Chemotherapy to Standard Cisplatin-Based Chemoradiotherapy in Uterine Cervical Cancer: Matter of Distant Relapse

Vanessa A Fabri et al. J Oncol. .

Abstract

Background: Treatment of advanced uterine cervical cancer has advanced little in the last 15 years. Although two phase III trials showed survival benefit with the addition of consolidation chemotherapy (CT) after cisplatin-based chemoradiotherapy (RTCT), it is not considered standard of care. We aimed to evaluate the benefit of consolidation CT compared to no additional treatment in patients treated with RTCT.

Methods: This is a retrospective study including 186 patients with FIGO stage IB2, IIA2, or IIB to IVB (paraaortic lymph nodes only) uterine cervical cancer who were treated with standard RTCT alone or RTCT followed by consolidation CT. Overall survival (OS), progression free survival (PFS), and the risk of distant and local relapses were compared between the two treatment groups.

Results: At 3 years OS was 91% versus 82.3% (p=0.027), PFS 84.3% versus 54.4% (p=0.047), and distant metastasis free survival (DMFS) 80.4% versus 62.5% (p=0.027) in favor of the consolidation CT group. Multivariate analysis confirmed the benefit of consolidation CT. There was no difference in locoregional free survival (LRFS). Positive lymph node was related to a higher risk of distant relapse. In the lymph node positive subgroup consolidation CT resulted in longer OS (p=0.050), PFS (p=0.014), and DMFS (p=0.022); in the lymph node negative subgroup there was no benefit from consolidation CT.

Conclusions: Use of consolidation CT resulted in longer OS and PFS, mostly due to control of distant relapses. Patients at higher risk of distant relapse showed the greatest benefit. This data generates a hypothesis that could help to better select patients to consolidation CT.

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Figures

Figure 1
Figure 1
Survival outcomes according to groups by treatment with consolidation CT and without consolidation CT. (a) Overall survival; (b) progression free survival; (c) distant metastasis free survival; (d) locorregional free survival. CT = chemotherapy. All p values calculated by Log-Rank Test.
Figure 2
Figure 2
(a) Overall survival in node negative subgroup according to treatment; (b) progression free survival in node negative subgroup according to treatment; (c) distant metastasis free survival in node negative subgroup according to treatment; (d) overall survival in node positive subgroup according to treatment; (e) progression free survival in node positive subgroup according to treatment; (f) distant metastasis free survival in node positive subgroup according to treatment. CT = chemotherapy. All p values calculated by Log-Rank Test.
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